"STRESS AND STRESS MANAGEMENT PROGRAMS"
STRESS AND STRESS MANAGEMENT PROGRAMS Adrienne Stauder MD, PhD, psychiatrist, psychotherapist Institute of Behavioural Sciences, Semmelweis University Budapest Hans Selye Hungarian Society of Behavioural Scienes and Medicine www.behsci.sote.hu, www.selyesociety.hu What is stress? Hans Selye (1907-1982, Hungarian born Scientist, works in Canada Introduces the term „stress” into everyday language His stress theory: the General Adaptation Syndrome (GADS): „The state manifested by a specific syndrome which consists of all the non-specifically induced changes within a biological system” The three phases of GADS: 1.Alarm reaction, 2. Resistance phase 3. Exhaustion phase The third is the most harmful, a consequence of chronic stress! („Vital exhaustion”) In widest sense: in the process of interrelationship between person and his/her environment those situations which need new behavioural responses Harmful or protective? Selye: eustress and distress Evolutionary model of stress: Stress responses act as triggers for the adaptive modification of the structure and the function of the brain. Stress responses serve to adjust in the physical, emotional and personality development in a self-optimising manner, in accordance with the ever-changing requirements of the external world. Canon alarm reaction: the fight or flight reaction Modern stress concept: the cognitive activation theory Stimulus: Stressor, perception Processing : filtering, appraisal, comparison, decision Physiological, emotional reactions - coping Coping: planned behaviour to adapt to the situation Acute severe stress: life-events //// chronic stress Work-stress is a more important for men Marital stress is more important for women Stress can cause disease, and chronic stress is a stressor •Coping: •emotional ways of coping •problem solving ways of coping •support seeking Real coping ability /// perceived coping ability The importance of positive psychology: •Learned resourcefulness: (Mihály Csikszentmihályi:Flow) •The experience of the controllability of stress situations •The ability to deal successfully with stressors strengthens the self- esteem, self-efficacy and the problem solving, coping skills of the person. EQ: Emotional intelligence (more important than IQ?) Mayer and Salovey, from the 1990ies Goleman: Social succesfulness Ability to identify, understand and express own feelings, and feelings of others (unable: alexithymia, Sifneos 1970is) Ability to use feeling The health consequences of psychosocial distress Psychosomatic symptoms Psychiatric disorders (anxiety, depression, post-traumatic stress d.) Employed workers die more frequently on Monday (AMI, CHD) People with higher education and socio-economic status live longer Immun dysfunctions (tumor in widows, common cold in exam periode) High prevalence of premature mortality especially for 45-60 years old • men is a major health issue in Hungary. Chronic stress due to rapid political and economical changes: challenge for adaptation and coping Behavioural medicine:what interventions can help? Need for intervention, especially in high risk groups Social support, building helping networks Improve stress management: Evidence based, cost effective, structured, easy to distribute interventions Community based programs- small group format Complex programs: Psychoeducation Identification of stressors and emotional reactions Appraisal - cognitive restructuring Relaxation techniques (both physical and psychological tension) Problem solving (e.g. time management, cooperation) Communication techniques eg. assertiveness, active listening, speaking about self (interpersonal conflicts, social support) Empathy (understanding others pperspectives ad reacctions) Emphasizing positives, humor Pleasureble activities, physical activities, hobbies Special issues: Life-style, disease management The Williams Life Skills program 16 hours, structured, small group intervention Effectiveness: Decreased perceived stress, anxiety, depression, hostility scores In CHD patients decreased resting blood pressure and heart rate In streesful situations, smaller increase in systolic blood pressure What are the effects of the program in high distress and healthy populations? I. Methods. Statistics: Paired Sample test pre / post intervention Sample High distress / psychosomatic group N=21 Psychosomatic Out-patient Clinic, internet 3 workshops, 28 participants 6 dropped out (21%), 1 no pre-intervention questionnaire 21 participants in data analyses 14 women/ 7 men, mean age: 31,8±8,7 ys (range 21-53) Students in medicine or psychology N=18 2 workshops, 21 participants 1 dropped out (5%), 1 no pre- 1 no post- intervention questionnaire 18 participants in data analyses 14 women/ 4 men, mean age: 24,7±4,3 ys (range) Questionnaires •PSS14 Perceived Stress Scale (Cohen et al, 1983) •STAI-T Spielberger Trait Anxiety (1970) •BDI Beck Depression Inventory, shortened (1961) •HOST Cook-Medley Hostility, shortened (1954) •PHQ15 Patients Health Questionnaire /PRIME MD somatic symptoms subscale (Kroenke 2002) •Life Meaning Stress and coping ss Rahe, Tolles (2002) •WHO WHO Well-Being, 5 item, Bech et al. (1996) •Satisfaction overall, how satisfied with your life? (1-10) •Happiness overall, how happy do you feel? (1-10) What are the effects of the program in high distress and healthy populations? II. Results by objective measures. High distress group: indices of distress significantly decreased on all scales and the means approached the normal range. There was a great decrease in PSS14, STAI-T, BDI, and a smaller on PHQ and hostility scores. Student group: indices of distress decreased, significantly for STAIT and BDI and nearly significant (p=0,08) for PSS14. High distress group: indices of well-being significant increased meaning in their life, they felt more satisfied and happier. Student group: Positive changes could be also observed in students, that was significant for WHO, Life meaning, satisfaction and happiness. III. Subjective evaluation of the Williams Life Skills program Scores 1-5 (not at all – very much) students / high distress groups •Satisfaction with the program: 4,06 / 4,35 •Satisfaction with Facilitator(s): 4,41 / 4,72 •Usefulness of the Workbook: 4,41 / 4,76 •Usefulness of other materials: 4,20 / 4,44 •Can use in my private life: 4,12 / 4,33 •Can use in my work: 4,29 / 4,24 Would you recommand the program to others? • 33 yes / 3 maybe / 0 no IV. Specific benefits of the stress management program • •General feedback: „I became more courageous.” „I’m glad that these are not such complicated techniques. It is something simple, but connects well to the complexity of life.” „By applying these skills, I managed to solve the problems I brought into and presented in the group.” •Relationship with partner: •„I am assertive with my ex-husband.” „When negotiating issues related to my divorce in a tense atmosphere, I could acknowledge the perspectives of my husband, and I tried to include positives among the negatives I said. I dared making concessions, and this allowed me to better represent the issues of special importance to me. We could reach an agreement without having fierce quarrels or being overwhelmed by negative feelings.” Parent –children relationships: „I managed to prevent arguments with my parents by using cognitive restructuring and active listening skills.” „I noticed changes in my relationship with my mother. Our relationship has improved since I use empathy, active listening, and speaking up.” „I managed to ease down the persistent problem with my teen by empathy and speaking up.” Applying life skills at work: „For my problems at work I use cognitive restructuring, thus I try to avoid bringing home my work related problems.” „I noticed that I am more patient with my patients, I don’t lose my temper so easily.” „I am more successful in getting round the nervous, impatient, and agressive patients.” „I managed to encourage a new colleague who had difficulties in adapting himself to our team.”